This application is provided by Nicholas Castle, a professor (tenured) in the Department of Health Policy & Administration (HPM), at the University of Pittsburgh. My long-term career goal is to apply my knowledge of nursing home operations to improve quality of resident care. As part of PAR-12-115 (K18) I have developed goals related to assessing the benefits and harms of health delivery system interventions to inform decision-making and, highlighting comparisons and outcomes that matter to people. This is in the emphasis area of care delivery and coordination for chronic care patients. The following steps are included as part of this proposal to achieve these objectives: 1) completing coursework in research methods in comparative effectiveness research methodology; 2) conducting well-mentored, rigorous patient-centered outcomes research (PCOR); 3) attending appropriate research meetings, seminars, and national conferences; and, 4) limiting teaching and administrative activities. The specific research proposed is to examine the use of consistent assignment of Nurse Aides in nursing homes. Touted benefits of consistent assignment are that: it improves quality of care, reduces staff turnover, and is preferred by staff. However, these beliefs are based on very little empirical evidence. Examining the impact of consistent assignment is thus significant, especially if it continues to be promoted as a means of improving care. It is uncertain how many nursing homes use consistent assignment. With respect to Patient Centered Outcomes (PCO); theoretically, consistent assignment of Nurse Aides is believed to strengthen the familiarity of staff with residents care requirements. As such, improvements in care should result. However, no rigorous empirical studies have examined the association of consistent assignment with PCO. Thus, in this proposal I will examine (1) the extent and level of consistent assignment in nursing homes of Nurse Aides; (2) the influence of Nurse Aide consistent assignment in nursing homes on PCO; (3) simulate outcomes related to specific policies requiring (and not requiring) Nurse Aide consistent assignment; and (4) identify (and distribute) key factors promoting successful implementation and use of consistent assignment. These activities will have a profound influence on the care of residents in nursing homes.